How does context influence performance of community health workers in low- and middle-income countries? Evidence from the literature

Background Community health workers (CHWs) are increasingly recognized as an integral component of the health workforce needed to achieve public health goals in low- and middle-income countries (LMICs). Many factors intersect to influence CHW performance. A systematic review with a narrative analysis was conducted to identify contextual factors influencing performance of CHWs. Methods We searched six databases for quantitative, qualitative, and mixed-methods studies that included CHWs working in promotional, preventive or curative primary health care services in LMICs. We differentiated CHW performance outcome measures at two levels: CHW level and end-user level. Ninety-four studies met the inclusion criteria and were double read to extract data relevant to the context of CHW programmes. Thematic coding was conducted and evidence on five main categories of contextual factors influencing CHW performance was synthesized. Results Few studies had the influence of contextual factors on CHW performance as their primary research focus. Contextual factors related to community (most prominently), economy, environment, and health system policy and practice were found to influence CHW performance. Socio-cultural factors (including gender norms and values and disease related stigma), safety and security and education and knowledge level of the target group were community factors that influenced CHW performance. Existence of a CHW policy, human resource policy legislation related to CHWs and political commitment were found to be influencing factors within the health system policy context. Health system practice factors included health service functionality, human resources provisions, level of decision-making, costs of health services, and the governance and coordination structure. All contextual factors can interact to shape CHW performance and affect the performance of CHW interventions or programmes. Conclusions Research on CHW programmes often does not capture or explicitly discuss the context in which CHW interventions take place. This synthesis situates and discusses the influence of context on CHW and programme performance. Future health policy and systems research should better address the complexity of contextual influences on programmes. This insight can help policy makers and programme managers to develop CHW interventions that adequately address and respond to context to optimise performance

“Who is going to believe me, if I say ‘I'm a researcher?’” — Scientists' role repertoires in online public engagement

This article contributes to reflective practice amongst scientists who engage with citizens in the digital public sphere, by exploring the scientists' experiences and underlying perspectives on their role repertoires in online science-society interactions. Semi-structured interviews were held with 26 European scientists to investigate their focus and contribution in boundary interactions, perspective on appropriate model of science communication, and activities, outputs and addressees in the digital public sphere — together comprising a role repertoire. The intended role of scientists often did not match with their deployed repertoire in online interactions with citizens. Participants were left with the feeling that the digital public sphere provides hollow interactions, devaluates scientific expertise or even represents a hostile environment. In order to capitalise on the promise of the digital public sphere for constructive interactions with a diverse public, a reflective practice is needed that aligns scientists' intended contribution to science-society interactions with the scientists' perspective and deployed online repertoires

“Who is going to believe me, if I say ‘I'm a researcher?’” — Scientists' role repertoires in online public engagement

This article contributes to reflective practice amongst scientists who engage with citizens in the digital public sphere, by exploring the scientists' experiences and underlying perspectives on their role repertoires in online science-society interactions. Semi-structured interviews were held with 26 European scientists to investigate their focus and contribution in boundary interactions, perspective on appropriate model of science communication, and activities, outputs and addressees in the digital public sphere — together comprising a role repertoire. The intended role of scientists often did not match with their deployed repertoire in online interactions with citizens. Participants were left with the feeling that the digital public sphere provides hollow interactions, devaluates scientific expertise or even represents a hostile environment. In order to capitalise on the promise of the digital public sphere for constructive interactions with a diverse public, a reflective practice is needed that aligns scientists' intended contribution to science-society interactions with the scientists' perspective and deployed online repertoires

Can Livelihood Capitals Promote Diversification of Resource-Poor Smallholder Farmers Into Agribusiness?: Evidence from Nyando and Vihiga Counties, Western Kenya.

The push towards the transformation of subsistence smallholder farming into market-oriented agribusiness has been in the public policy debates of many low- and middle-income countries, including Kenya. While various studies have highlighted the lack of livelihood capital as a reason for most smallholders not to diversify into agribusiness. How these livelihood capitals influence smallholders' decisions and choices have, however, only been partially researched. Using systematic random sampling, 392 households in Western Kenya were interviewed through a researcher-administered questionnaire. The multinomial logistic regression method was used to analyze the data. The findings reveal that livelihood capitals acted in parallel and jointly to determine the decisions of smallholders to participate in agribusiness. Results show that education level, gender, landholding size, distance to markets, farm input access, and agriculture extension services positively and significantly influenced the decision choices of households to participate in agribusiness. Households with higher livelihood capital accumulation resulted in a higher probability of participating in agribusiness while those with limited livelihood capital resulted in a lower probability to participate in agribusiness. We argue that designing appropriate pro-poor targeted policy interventions to improve households’ livelihood capital could address the problem of non-participation of poor rural smallholders in agribusiness markets

Leadership for Empowerment: Analyzing Leadership Practices in a Youth Care Organization Using Peer Video Reflection

In recent years, increased complexity and persistent challenges induced governmental organizations to transform their ways of operating. Inherent to such transformations are shifts in approaches to leadership and organizational learning. However, adopting strategies that empower staff to take complex context-appropriate decisions has shown to be difficult. This paper aims to gain insight into empowering and disempowering leadership practices in complex transformation processes. Team leaders of a governmental organization participated in observing videos of weekly team meetings, noting positive and negative interactions between the peer-team leader and team members. Their observations were analyzed using the four dimensions of psychological empowerment. All team leaders showed empowering and disempowering practices within one case discussion. The findings illustrate in which contexts these practices are triggered. Results help to theoretically elucidate academic debates about the relationships between empowerment and control, differences between empowerment and laissez-faire and between empowering and destructive leadership in human service organizations

Why do some Lao mothers have good practices during pregnancy? A qualitative positive deviance study

Objectives: Optimal antenatal care (ANC) visits help improve health outcomes and decrease perinatal mortality but they are often not optimal in low and middle-income countries (e.g., few mothers attend the recommended four or more ANC visits). The aim of this study was to identify determinants that influenced mothers who did make sufficient visits for ANC in rural Lao in order to inform the design of more effective interventions to change the behavior of mothers who do not make such visits. Materials and Methods: A qualitative study was conducted using semi-structured interviews with mothers who made four or more ANC visits during their last pregnancy in rural Lao. Manual analysis was used for open and thematic coding of the interview data. Results: All mothers reported taking special care of themselves during pregnancy. They perceived the clear benefits of ANC visits regarding reassuring them of their health and reducing the risk of negative events. Family members, particularly husbands, played a key role in making decisions to seek more ANC when they were aware of its benefits. In addition, friends and neighbors were an important source of information for mothers. The quality of ANC provision and the provision of incentives such as an information booklet, along with soap and mosquito net were directly influencing factors in increasing ANC visits. Conclusions: In general, feeling a need for taking special care during pregnancy was a common factor among pregnant women who did use ANC in rural Laos. Accordingly, improving the quality of ANC and increasing appreciation in communities regarding the need for good ANC are strongly recommended to increase attendance by all mothers